Estrogen way to low on TRT protocol with NO AI

[JamesPN007]

Hello ExcelMale Community,

My apologies for the long post. I am fairly new the to site and to TRT (about 3 months in). I finally took the plunge to address my low T, got my labs done, contacted Defy, and had my consultation with Dr. Saya. I turned to Defy as a result of main symptoms being rapid unexplained weight gain, fatigue, brain fog, low libido. BTW I'm a 40 year old male, 5ft6in, currently approx. 180pounds. About 2 years ago I was lean and fit at 150 pounds and felt in great health. Funny how things turn around so quickly!!

Turns out I had symptoms of both low T and hypothyroidism, and Defy started me on a protocol to address both, based on my initial labs. I just had my 3 month labs done, and I'm waiting on my follow up consult with Dr. Saya (5 weeks out YIKES!!). I'm currently trying to get an earlier appointment with someone in the practice to address my concerns (fingers crossed).

Initial protocol as follows:
- Test Cyp 140mg/week injected every 3.5days (70mg per injection) IM or subQ
- 400IU HCG injected every 3.5 days
- 1.5 grain Armour Thyroid taken 1gr in am and 0.5gr in pm
- 15mg DHEA 1cap at night before bed
- Other supplements include multi-vitamin and Fish Oil.

My main concern is I've been having symptoms of what I thought was high estrogen (low libido, fatigue, no loss of accumulated belly fat) . My initial Free T and Estradiol numbers were 346 and 10.9, respectively. After 3 months on the above protocol my Free T and Estradiol numbers were 1008 and <2.5, respectively. I'll post full pre and post labs below.

A couple weeks in I started to feel slight improvement in health, energy, libido, etc., but those effects tapered off after a few weeks and my initial symptoms started to come back. My main symptoms currently are crashed libido and difficulty getting/maintaining erections, and no improvement in loss of belly fat despite diet and exercise being in-check. I thought this may be due to Estrogen increasing along with T, but based on my labs the opposite seems to be the case.

I haven't taken an AI, and as far as I know I am not taking any supplements that would be reducing my Estrogen to such an extremely low level. Any ideas what could be causing this and how I can address the Estrogen issue? Any advice would be greatly appreciated.

INITIAL LABS:

CBC With Differential/Platelet
WBC 6.0 x10E3/uL 3.4 - 10.8
RBC 5.00 x10E6/uL 4.14 - 5.80
Hemoglobin 15.1 g/dL 13.0 - 17.7
Hematocrit 44.7 % 37.5 - 51.0
MCV 89 fL 79 - 97
MCH 30.2 pg 26.6 - 33.0
MCHC 33.8 g/dL 31.5 - 35.7
RDW 13.6 % 12.3 - 15.4
Platelets 214 x10E3/uL 150 - 379
Neutrophils 49 % Not Estab.
Lymphs 36 % Not Estab.
Monocytes 6 % Not Estab.
Eos 8 % Not Estab.
Basos 1 % Not Estab.
Neutrophils (Absolute) 2.9 x10E3/uL 1.4 - 7.0
Lymphs (Absolute) 2.2 x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.4 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.5 High x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.1 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 % Not Estab.
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1

Comp. Metabolic Panel (14)
Glucose, Serum 94 mg/dL 65 - 99
Specimen received in contact with cells. No visible hemolysis
present. However GLUC may be decreased and K increased. Clinical
correlation indicated.
BUN 21 mg/dL 6 - 24
Creatinine, Serum 0.98 mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 96 mL/min/1.73 >59
eGFR If Africn Am 111 mL/min/1.73 >59
BUN/Creatinine Ratio 21 High 9 - 20
Sodium, Serum 141 mmol/L 134 - 144
Potassium, Serum 4.0 mmol/L 3.5 - 5.2
Specimen received in contact with cells. No visible hemolysis
present. However GLUC may be decreased and K increased. Clinical
correlation indicated.
Chloride, Serum 100 mmol/L 96 - 106
Carbon Dioxide, Total 26 mmol/L 18 - 29
Calcium, Serum 9.2 mg/dL 8.7 - 10.2
Protein, Total, Serum 6.6 g/dL 6.0 - 8.5
Albumin, Serum 4.6 g/dL 3.5 - 5.5
Globulin, Total 2.0 g/dL 1.5 - 4.5
A/G Ratio 2.3 High 1.2 - 2.2
Bilirubin, Total 0.3 mg/dL 0.0 - 1.2
Alkaline Phosphatase, S 42 IU/L 39 - 117
AST (SGOT) 20 IU/L 0 - 40
ALT (SGPT) 20 IU/L 0 - 44

Lipid Panel w/ Chol/HDL Ratio
Cholesterol, Total 229 High mg/dL 100 - 199
Triglycerides 193 High mg/dL 0 - 149
HDL Cholesterol 58 mg/dL >39
VLDL Cholesterol Cal 39 mg/dL 5 - 40
LDL Cholesterol Calc 132 High mg/dL 0 - 99
T. Chol/HDL Ratio 3.9 ratio units 0.0 - 5.0

Testosterone,Free and Total
Testosterone, Serum 346 ng/dL 264 - 916
Free Testosterone(Direct) 5.6 Low pg/mL 6.8 - 21.5

DHEA-Sulfate 196.3 ug/dL 102.6 - 416.3

TSH 0.925 uIU/mL 0.450 - 4.500

Luteinizing Hormone(LH), S
LH 5.7 mIU/mL 1.7 - 8.6

Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.8 ng/mL 0.0 - 4.0

Estradiol, Sensitive 10.9 pg/mL 8.0 - 35.0

Sex Horm Binding Glob, Serum 43.8 nmol/L 16.5 - 55.9



FOLLOW UP LABS:

CBC With Differential/Platelet [Final]
Notes Fasting - No
WBC x10E3/u 3.4-10.8
L
6.0
RBC x10E6/u 4.14-5.80
L
5.51
Hemoglobin 16.6 g/dL 13.0-17.7
Hematocrit 48.9 % 37.5-51.0
MCV 89 fL 79-97
MCH 30.1 pg 26.6-33.0
MCHC 33.9 g/dL 31.5-35.7
RDW 12.9 % 12.3-15.4
Platelets x10E3/u 150-379
L
198
Neutrophils 51 % Not Estab.
Lymphs 32 % Not Estab.
Monocytes 8 % Not Estab.
Eos 8 % Not Estab.
Basos 1 % Not Estab.
Immature Cells NP
Neutrophils (Absolute) x10E3/u 1.4-7.0
L
3.1
Lymphs (Absolute) x10E3/u 0.7-3.1
L
2.0
Monocytes(Absolute) x10E3/u 0.1-0.9
L
0.5
Eos (Absolute) x10E3/u 0.0-0.4
L
0.5 H
Baso (Absolute) x10E3/u 0.0-0.2
L
0.0
Immature Granulocytes 0 % Not Estab.
Immature Grans (Abs) x10E3/u 0.0-0.1
L
0.0

Comp. Metabolic Panel (14) [Final]
Glucose 88 mg/dL 65-99
BUN 26 H mg/dL 6-24
Creatinine 0.95 mg/dL 0.76-1.27
eGFR If NonAfricn Am mL/min/1 >59
.73
100
eGFR If Africn Am mL/min/1 >59
.73
115
BUN/Creatinine Ratio 27 H 9-20
Sodium 140 mmol/L 134-144
Potassium 4.6 mmol/L 3.5-5.2
Chloride 96 mmol/L 96-106
Carbon Dioxide, Total 24 mmol/L 18-29Calcium 9.5 mg/dL 8.7-10.2
Protein, Total 6.7 g/dL 6.0-8.5
Albumin 4.6 g/dL 3.5-5.5
Globulin, Total 2.1 g/dL 1.5-4.5
A/G Ratio 2.2 1.2-2.2
Bilirubin, Total 0.4 mg/dL 0.0-1.2
Alkaline Phosphatase 42 IU/L 39-117
AST (SGOT) 25 IU/L 0-40
ALT (SGPT) 22 IU/L 0-44

Lipid Panel w/ Chol/HDL Ratio [Final]
Cholesterol, Total 221 H mg/dL 100-199
Triglycerides 234 H mg/dL 0-149
HDL Cholesterol 51 mg/dL >39
VLDL Cholesterol Cal 47 H mg/dL 5-40
LDL Cholesterol Calc 123 H mg/dL 0-99
Comment: NP
T. Chol/HDL Ratio 4.3 ratio 0.0-5.0

Testosterone,Free and Total [Final]
Testosterone, Serum 1008 H ng/dL 264-916
Free Testosterone(Direct) 19.2 pg/mL 6.8-21.5

Thyroxine (T4) Free, Direct, S [Final]

T4,Free(Direct) 1.40 ng/dL 0.82-1.77

DHEA-Sulfate [Final]
DHEA-Sulfate 366.3 ug/dL 102.6-416.3

TSH [Final]
TSH 0.268 L uIU/mL 0.450-4.500

Prostate-Specific Ag, Serum [Final]
Prostate Specific Ag, Serum 1.1 ng/mL 0.0-4.0

IGF-1 [Final]
Insulin-Like Growth Factor I 184 ng/mL 83-233

Estradiol, Sensitive [Final]
Estradiol, Sensitive <2.5 L pg/mL 8.0-35.0

Triiodothyronine,Free,Serum [Final]
Triiodothyronine,Free,Serum 3.9 pg/mL 2.0-4.4

Sex Horm Binding Glob, Serum [Final]
Sex Horm Binding Glob, Serum 36.3 nmol/L 16.5-55.9
​

 

[lowe2sucks]

im curious if your estrogen would go up if you would stop dhea
i am 100% positive dhea cream crashed mine estrogen but according to knowledge we have it should raise estrogen.. it's worth trying to stop it and see if your e2 goes up imo
your testosterone and dhea-s went up but e2 got crashed.. it's against all the knowledge we currently have or maybe we just have wrong knowledge

 

[30005Gator]

From what pharmacy are you getting your Test Cyp? APS Pharmacy blends Arimidex with their Test Cyp, and wondering if you got the wrong vial.

 

[JamesPN007]

What pharmacy are you getting your Test Cyp?

​

Test Cyp, HCG and DHEA are coming from Empower, the compounding pharmacy that Defy works with. The label on the vial does not state that it contains Arimidex or any other AI, only Test Cyp 200mg/ml.

From what I've read here, Empower also adds Arimidex with the Test Cyp when the scrip calls for it, but I doubt that they would have mis-labeled the vial. I just ran out of the compounded Test Cyp from Empower and had my new scrip called in to Walgreens, so even if that was the issue hopefully it wouldn't be going forward.

 

[JamesPN007]

im curious if your estrogen would go up if you would stop dhea
i am 100% positive dhea cream crashed mine estrogen but according to knowledge we have it should raise estrogen.. it's worth trying to stop it and see if your e2 goes up imo
your testosterone and dhea-s went up but e2 got crashed.. it's against all the knowledge we currently have or maybe we just have wrong knowledge

From what i understand the DHEA caps, which are also from Defy's compounding pharmacy, are fairly low dose. I actually didn't re-order more DHEA as I never really feel like "supplements" do anything for me.
Maybe in my case they are doing too much lol, but I doubt it. Either way, I'm completely baffled as to how my E2 crashed.

 

[FeelingLost]

Hi James, Welcome to the forum and the Defy club which I and many others here are a member. Your story is a strange one no AI 140mg/wk and a crash E2.
I would have guessed the lab messed up your blood tests but you are discribing low E2 symtoms to the letter. For most of us guys lowTsucks excluded DHEA and HCG raised E2.
Having a crashed E2 is pretty major I would think Defy would want to talk with you. Have you called them about this latest blood test? I don't want to offer advice if they are already treating you for low E2. Two cooks in the kitchen is a very bad idea. IMO
again welcome.

 

[JamesPN007]

Hi James, Welcome to the forum and the Defy club which I and many others here are a member. Your story is a strange one no AI 140mg/wk and a crash E2.
I would have guessed the lab messed up your blood tests but you are discribing low E2 symtoms to the letter. For most of us guys lowTsucks excluded DHEA and HCG raised E2.
Having a crashed E2 is pretty major I would think Defy would want to talk with you. Have you called them about this latest blood test? I don't want to offer advice if they are already treating you for low E2. Two cooks in the kitchen is a very bad idea. IMO
again welcome.

Thanks for the reply. I called Defy to see if I can get an earlier appointment with ANYONE that can help address this blood test and symptoms and am awaiting a call back. In the meantime I'm left wondering how this could have happened and what I can do to fix it. Addressing high E2 on TRT is "easy"...take an AI...but addressing crashed E2 (I'm guessing <2.5 is crashed...worse than just low)? I'm freaking out right now because it's starting to affect my relationship and my work and I don't know to address it.

 

[FeelingLost]

Thanks for the reply. I called Defy to see if I can get an earlier appointment with ANYONE that can help address this blood test and symptoms and am awaiting a call back. In the meantime I'm left wondering how this could have happened and what I can do to fix it. Addressing high E2 on TRT is "easy"...take an AI...but addressing low E2? I'm freaking out right now because it's starting to affect my relationship and my work and I don't know to address it.

Do your best to hold it together. This will pass. My first 6 months starting TRT sucked and it sucks for most of us. Just know it is not permanent you will get over this.

Have a talk with your significant other and ask for their understanding and help. That was the only way I got thru my neg side when starting. At work you just got to hold your temper like when a new shitasss boss comes on board. An don't forget we are here to help if we can. Talking with other that have been thru this really does help.

 

[Vince]

I can't believe you're estradiol levels are that low, if you're not using an AI definitely would have them retest your E2 levels. Your diet must be terrible with those high triglycerides. I would clean up your diet. Both DHEA and HCG will increase your estradiol.

 

[JamesPN007]

I hear ya man. Me and the gf (who is gorgeous btw) both had high libido when we met 2 years ago (and even just a year ago), before my low T issues started. Problem is she still has the same high libido but mine has been in the toilet for the last 6 months or so. She can literally throw herself at me and I can either take it or leave it (if I can even manage to get myself going in the first place).

And the work issue is not at all temper related, more like I have this brain fog and lack of energy/motivation to focus and get my work done.


These are pretty much the same symptoms I had BEFORE I started TRT, when I had low T AND fairly low E2. Although the T is at the top of the "normal" range, maybe even a little higher, I wonder if the extremely low E2 is what's causing my current symptoms.

 

[JamesPN007]

I can't believe you're estradiol levels are that low, if you're not using an AI definitely would have them retest your E2 levels. Your diet must be terrible with those high triglycerides. I would clean up your diet. Both DHEA and HCG will increase your estradiol.

Hi Vince. Yes, I'm also wondering if there was a problem with the blood test. I would have thought the TRT/HCG would increase my E2 levels, not decrease them.

As for diet, it's actually very clean and consistent during the weekdays, though I'm a little less strict during the weekend but still conscious of macro intake...daily nutrition consists of:
- morning: latte with reduced fat milk, and lean whey/casein protein shake
- snacks during day: 3 hard boiled eggs, veggies/hummus, blueberries/strawberries, whey/casein protein shake
- lunch: salad with 6oz. grilled chicken breast and low calorie greek dressing
- dinner: grilled chicken, fish, or lean red meat with veggies
- occasional evening dessert: cappuccino with a piece of dark chocolate

If there is anything terrible in my diet above that I need to clean up, please let me know. I cleaned my diet up about 5 years ago and went from 205lbs down to 150lbs eating and exercising the same way I do now.

Exercise 3-4x per week consists of a higher rep variation of the stronglifts 5x5 exercises (bench, squats, deadlift, row, shoulder press) with HIIT interspersed between lifting exercises.

My weight started creeping back up from 150 to 185lbs, and that combined with the other symptoms I already mentioned is what led me to seek treatment.​

 

[Dr Justin Saya MD]

Most likely explanation is actually lab error - have staff send you a repeat sensitive estradiol lab order. If confirmed on repeat test, then there is something more esoteric going on to require discussion.

The belly fat issue may tie into your increasing TG level - can be from carbs, alcohol. Often is an indicator of some insulin resistance present. Metformin 500mg ER BID often helps along with reducing carbohydrate intake. I will approve this for you prior to consult. Forward this thread to staff when you contact.

 

[Vince Carter]

I saw this before lunch but didnt have a moment to reply but I was too going to suggest lab error and to retest.

 

[Vince]

I don't know if this will help you but I'm a big low-carb high-fat eating guy. My lipid panel is awesome.

Vince's Latest Lipid Panel From 10/9/17

https://www.excelmale.com/forum/showthread.php?12290-Vince-s-Latest-Lipid-Panel-From-10-9-17

 

[JamesPN007]

Thank you Dr. Saya!! The office actually called back a little while ago and I have a consult with one of the NP's this afternoon. Will forward this thread to them as you said.

Most of my carb intake is usually limited to a couple servings of fruit per day (handful of berries, and an apple or banana). Fruit has never been a problem for me in the past, but I suppose with age and changing hormones anything is possible. My alcohol intake is also very limited, 1-2 glasses of red wine per week at most. Sounds like at least for now I will have to be even more conscious of carbs as a % of total caloric intake and see where that takes me.

Vince - numbers look great!! Before cleaning up my diet/exercise about 5 years ago I was on low dose Crestor daily. However, with my diet/exercise and resulting weight loss my lipids improved dramatically to where the Crestor was no longer needed. I'm working to get myself back to that point.

 

[Mr. T]

One other thought... Double check the labels on the NDT and especially the DHEA to make sure they are not Arimidex.

 

[JamesPN007]

One other thought... Double check the labels on the NDT and especially the DHEA to make sure they are not Arimidex.

The NDT is from Walgreens and is definitely not Arimidex. The DHEA is from Empower and the label says DHEA 15mg, but is in green/white capsules with no markings on them, so who knows what they really are.

I had a phone consult yesterday with Defy and they advised as Dr. Saya stated above, that it was likely a lab error and to re-test in a few weeks. They also changed up my protocol slightly to address these symptoms in the meantime. I'm glad Defy was on top of this and able to accommodate an appointment so quickly to address my concerns. Will keep this thread updated with the new labs in a few weeks. Thanks everyone for your advice!!

 

[rcwood76]

Hey James, I had the same issues as you in the beginning. Started with Defy in January 2018 with E2 at 3. After 3 months it had gone to 10 with no or very little anaztrozole. Since April I have seen a marked difference especially adding DHEA 25mg. I don't know if you have this problem but for a while the insomnia was horrible but the last three weeks have been much better and the brain fog is going away. Defy will get you straightened out and Dr. Saya is beyond great. Hang in there and it will get better. Before you know it your girl will be begging you to leave her alone.